An Essay Collection On The Interconnectedness Of Poverty, Trauma, And .

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The knot:An essay collection onthe interconnectednessof poverty, trauma, andmultiple disadvantageForeword byJulian Corner (Lankelly Chase)Edited byRevolving Doors Agency

2The knot:An essay collection onthe interconnectednessof poverty, trauma, andmultiple disadvantageThe knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageAbout Revolving Doors AgencyRevolving Doors Agency is a national charity that aims tochange systems and improve services for people ‘in therevolving door’ – people who come into repeat contactwith the criminal justice system because of traumatic lifeevents, persistent poverty, and multiple unmet needs suchas mental ill-health, homelessness and substance misuse.We work to create a smarter criminal justice system thatmakes the revolving door avoidable and escapable, resultingin safer communities. We do this by working alongsidenational and local decision-makers. We combine livedexperience insight, robust research and system knowledgeto create policy and practice solutions that work.About Lankelly ChaseLankelly Chase is a charitable foundation focused on severeand multiple disadvantage. Our mission is the creationof systems of justice, healing and liberation that enablepeople who are subject to extreme marginalisation to livewith dignity and opportunity in supportive communities.Our mission is to work with partners to change systems ofinjustice and oppression that result in the mental distress,violence and destitution experienced by people subjectto extreme marginalisation in the UK. We don’t think anyone person or organisation has all the answers; insteadwe aim to build, nurture and support partnerships andnetworks which seek to act, reflect on, learn and adaptto how we can all model the change we want to see.AcknowledgmentsWe would first like to thank our contributors for writingsuch interesting and thought-provoking essays, particularlygiven the challenging circumstances caused by COVID19. We would also like to thank members of our editorialreview board, Sue Wheatcroft, Nina Viswani, CarolHedderman, Stephen Crossley and Oliver French, for theirinvaluable help in reviewing and shaping the collection.We also thank our external reviewers who providedextremely helpful feedback on essay drafts. Lastly, wewould like to thank Lankelly Chase for funding this workand providing us with the opportunity to bring togethercritical insights, lenses and solutions in this collection.Disclaimer statementThe views and opinions expressed in these essays are thoseof the authors and do not necessarily reflect the views orpositions of Lankelly Chase or Revolving Doors Agency.The knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageContents04 ForewordJulian Corner (Lankelly Chase)06 IntroductionDr. Philip Mullen (Revolving Doors Agency)08 A continuum of harm: How systemic interactions canmultiply and entrench complex disadvantageDr. Diana Johns,Jaime de Loma-Osorio RiconDr. Eric Dommers18Where next for poverty and inequality in the UK?Professor Tracy Shildrick28Understanding multiple inequalities and traumaneeds through a gendered lens: The case for inclusivegendered approaches to trauma-informed careDr. Deborah MorrisElanor Lucy Webb40 The central role of racism in shaping the lifeexperiences of ethnic minority people in the UKProfessor James Nazroo50 Trauma-informed or trauma-inducing? The criminal justicesystem as an active player in the perpetration of traumaDr. Sarah Anderson62Adversity and injustice: Reframing and claiming our responsibilitiesDr. Michael SmithKaty Hetherington72Towards a human rights approach to multiple disadvantageMiranda Keast82Child trauma as a source of lifetime inequality –the impacts on mental health and violent behaviourProfessor Antonia Bifulco3

4The knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageThe knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageForewordBy Julian Corner, Lankelly ChaseIn his historical study of the invention andreinvention of the concept of ‘the underclass’,John Welshman shows repeatedly thatthe way social problems are defined, andthe design of attempts to tackle them,tells us a great deal about the ideologiesof the people defining the problem andvery little about the actual lives of thepeople and the families being targeted.I was reminded of Welshman’s1 work while reading thisnew collection of essays on the interconnection of poverty,trauma and multiple disadvantage. The framing of multipledisadvantage put forward by these essays is so compellingthat it caused me to reflect on why it hasn’t always beenmy main frame of reference. Until a few years ago, I wouldhave viewed poverty and trauma as important contextualfactors in understanding multiple disadvantage, but Iwouldn’t have put them front and centre of any response.After reading the essays, I revisited a 2002 Social ExclusionUnit report that I helped to research and write, ‘Reducingre-offending by ex-prisoners’. This report was widelywelcomed at the time and yet it makes sobering readingnow. Poverty is hardly mentioned, I found scant referencesto trauma and abuse, and the analysis of issues facedby women and by black and minority ethnic prisoners isrelegated to annexes. It is more sobering still to see thatthe report’s actions and recommendations owe very littleto any understanding we may have had of these issues.In 2002, we would have been surprised to be toldthat our work wouldn’t age well. We believed that wewere viewing social problems with as much empiricalobjectivity as we could muster, that our unprecedentedtrawl of evidence was unmediated by ideology. Sohow did we miss or downplay such critical issues?Many reasons spring to mind, but there is a unifyingtheme: rights and responsibilities. Our report soughtto offer a comprehensive package of ‘solutions’ to theproblems that released prisoners faced, and it framedthis as a new deal between the citizen and the state.The state would put in place the support you neededto turn your life around, however if you failed to seizethe opportunities offered to you, then there would be,in the words of one Minister, ‘no more excuses’.This deal was both fragile and one-sided. Fragilebecause the state could never anticipate and addressthe needs of every prisoner, and so couldn’t possibly1.keep its side of the deal. One-sided because theconsequences of the state failing to provide sufficientsupport were limited to wasted revenue, whereas theconsequences for the prisoner could be catastrophic.By framing rehabilitation as a ‘deal’, it became almostinevitable that poverty and trauma would be marginalised.If the state allowed their centrality, then it was onlyone or two steps away from acknowledging its ownresponsibility for failing to prevent these harms. Suchan acknowledgement would then take the stateperilously close to a reciprocal deal, with rights andresponsibilities on both sides. Much safer to limit thestate within the boundaries of managerialism.Looking back, it is still curious that a government that wasso committed to reducing child poverty and to investingin Sure Start should have been entirely unwilling to joinup the dots with its approach to adults. At that point, thestate’s failings across the lifespan of most prisoners couldbe laid at the door of 18 years of the previous government.So why didn’t Labour attribute the prison population tothe Conservatives’ failure to prevent poverty and trauma?The most obvious reason was that Tony Blair knewa large percentage of the public viewed prisonersas entirely culpable, and that his government wouldbe punished for any blurring of that line. He had thepolitical capability to try to shift the public’s view, buthis criminal justice arms race with Michael Howardwhile in opposition had blocked that route.There was another reason though, which relates to the Blairgovernment’s belief in ‘solutions’. Often within a term of aparliament, and to an arbitrary target, Blair’s governmentbelieved it could solve an intractable issue throughsuperior design of and investment in services. Such beliefcould only be underpinned by the most reductive ofassumptions: that individual choices were rational, thatjustice was binary, and that the demarcation between childand adult was absolute. Any blurring risked opening thefloodgates to the anathemas of relativism and complexity.With the government holding complexity at bay, civilservants were able to act. This was an exciting, optimistictime for many of us who hoped to change things forgood. And we did do some good. But we also did a lotof harm. Looking back, we were astonishingly naïveto think that service provision alone could correct theeffects of structural inequality and long-standing injusticeon the lives of people who had no reason to trust us.This essay collection speaks directly to this knottiness.Alongside invaluable updates of the state of knowledge onboth poverty and trauma, these essays suggest frameworksWelshman, J. (2006). Underclass: A history of the excluded since 1880. London: Bloomsbury.that can help us to incorporate more dimensions into ourthinking and action, to join up the dots better, both at thelevel of individual interventions and at the level of policy.In Professor James Nazroo’s terms, these essays allow usto find greater connection between our understandingsof the structural, interpersonal and institutional layers.The proposed frameworks encompass the therapeuticjustice-social ecological lens formulated by Dr DianaJohns, Jaime de Loma-Osorio Ricon and Dr Eric Dommers,through to the globally recognised capabilities approachwhich underpins two of the essays. The frameworks are notintended to fully resolve the tensions that arise in relation tomultiple disadvantage nor do they hope to perfectly alignthe different layers. They are not a template for an idealresponse. Their intention is to help each of us – practitioner,civil servant or political activist – to locate ourselveswithin a shared appreciation of the multiple dimensionsat play, and to inquire into what would emerge if therewere growing coherence between those dimensions.These essays will undoubtedly give me, and hopefullymany others, more tools and structures for three crucialchallenges. First, to engage with the interconnectionsof poverty, trauma, and multiple disadvantage in waysthat reduce overwhelm and paralysis and enable actionand learning. Second, to examine the degree to whichour own practice inadvertently reproduces injustices,and to find ways in which our choices can do more goodand less harm. And third, to locate our own ideologicallenses clearly enough so that, in the words of Jones,Ricon and Dommers, we are able to “see possibility,potential, growth and a future of radical inclusion”.Despite the challenges and harms documented in theseessays, I finished them feeling more optimistic. This isn’tbecause they offer ‘solutions’. Precisely because they avoidsuch reductivism, they lay the groundwork for approachesto multiple disadvantage that are more grounded in thereality of people’s lives and that connect those livesto a wider vision of a fair and sustainable society.5

6The knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageThe knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantage7IntroductionBy Dr. Philip Mullen, Revolving Doors AgencyPeople who repeatedly offend now accountfor about 40% of all offenders,1 whilereoffending accounts for three quartersof all proven offences. While this groupmay be portrayed by some as hardenedcriminals, we know that many are trappedin a revolving door cycle of crisis and crimethat drives their offending. We also know,through our research and lived experienceforums, that these cycles are marked byclusters of significant disadvantage –starting from childhood and continuinginto adulthood, and sometimes entrappingmultiple generations within families.Through these conversations with people with livedexperience of the revolving door of crisis and crime wehave heard about multiple experiences of neglect, abuse,trauma and household dysfunction, and multiple and oftentraumatic losses and bereavements primarily driven bymental ill-health and drug overdose. We have also heardabout experiences of persistent community violence – offriends, family members and neighbours being beatenup, murdered, and subjected to racial discrimination. Allthese challenging experiences happen in the context ofprofound poverty, of having no option but to live in unsafe orunsuitable accommodation, being unable to afford enoughfood to feed the family, high levels of school exclusion,and persistent and intergenerational unemployment.To capture the complexity and interconnectedness ofthese issues, many of our lived experience forum membershave used the metaphor of a knot. They describe it ascapturing how these issues are intertwined but also asgiving hope that they can start to be unpicked – they don’tcharacterise the problem as such a tangled mess thatit can never be resolved. To do so effectively, however,requires service providers and policy-makers to first takea step back to understand how these issues are knottedtogether, rather than immediately jumping in to try toresolve a single issue or issues. As a result of taking thisstep back, our members argue that agencies are betterplaced to avoid creating additional knots and to see howthey can work collaboratively to address these knottedissues more effectively. We have titled this collection‘The Knot’ to highlight both the complexity of intertwinedissues of poverty, trauma and multiple disadvantage,and also the necessity of collaborative and well-thoughtout responses to effectively address these issues.At Revolving Doors, we have always recognised that thosetrapped in the revolving door of crisis and crime face thesemultiple and knotted disadvantages, but traditionally wehave focused more on outcomes and mitigating againstthese. Our work more recently, however, as highlightedthrough our 2020-2024 strategy2 and New GenerationPolicing project3, has moved us more upstream, to betterunderstand how poverty, trauma and structural disadvantagecombine to create and perpetuate multiple disadvantage.This essay collection, kindly supported by Lankelly Chase,is a key contribution to the shift in this direction. We aim tosupport a more nuanced understanding of how poverty,trauma and structural disadvantage create and perpetuatemultiple disadvantage, and how we can more collaborativelyand systematically respond to their root causes.In putting the collection together, we chose to approachcontributors both across and beyond academia, includingthrough our Research Network on Severe and MultipleDisadvantage, to support wider conversations anddebates beyond disciplinary and sectoral silos. As wewere eager for the collection to be accessible to a range ofaudiences, we have also worked with our contributors toconsider how their research and arguments can be madein ways that encourage engagement and collaborationbetween academics (of various disciplines), people withlived experience, practitioners and policy-makers.Although it is not possible to cover every topic andperspective in just one publication, we hope the collectionoffers the reader new lenses and frameworks for betterunderstanding the complex interconnections betweenpoverty, trauma and multiple disadvantage. Some ofthe lenses used to explore these interconnections in thecollection include gender, race, human rights and capabilities,age and Adverse Childhood Experiences, place and time,public health, the criminal justice system and Covid-19.We also hope the collection encourages the reader to pause,reflect on, and have conversations about how we can betterrespond to these complex interconnections, as serviceproviders, policy-makers, researchers, and people with livedexperience, in more collaborative and systemic ways.At Revolving Doors, we have already started some ofthese conversations, with many of our contributorsdiscussing their essays at our regional lived experienceforums, and reporting that these discussions have helped1. Ministry of Justice. 2019. Offenders convicted for indictable offences by previous criminal history, year ending March 2009 to 2019. Table Q6.1. London: Ministry of Justice.2. ad?token 75C9zzC13. ion-revolving-doorto inform their thinking and understanding of the issuesand potential solutions. Our lived experience membershave also found these conversations valuable, learningmore about existing research on the issues and havingspace to discuss important structural issues at the heartof their contact with the criminal justice system.While we had initial concerns about how to cover traumaticsubjects safely in online forums, our members emphasisedthe necessity of exploring challenging topics to work towardspositive systems change. In response, we have worked closelywith our members to further develop our online forum modelto minimise the risk of discussions being re-traumatisingwhile also providing space to discuss challenging topics.These conversations between our contributors and livedexperience membership will continue through our upcomingseries of podcasts, to be launched in early 2021, to furtherexplore interconnections and our systemic responses to them.In the collection’s opening essay, Dr Diana Johns, SeniorLecturer of Criminology at the University of Melbourne, andJaime de Loma-Osorio Ricon and Dr Eric Dommers,both practitioners working for a community hub, explorethe interconnectedness of poverty, trauma and multipledisadvantage in a disadvantaged Australian neighbourhood.They argue that lenses of social ecology, therapeutic justiceand a continuum of harm help to illustrate the processesby which exclusion and marginalisation become layeredwith shame, and how trauma and disadvantage becomeembedded across generations. They also illustrate howdifferent kinds of interactions between practitioners, childrenand families, compared to current practice, are necessary forinterrupting these processes of exclusion and marginalisation.Next, Professor Tracy Shildrick, Professor of Inequalitiesat Newcastle University, reviews labour market, economicand political changes over the last few decades and theimpacts these have had on rates of poverty and inequalityin the UK. Through exploring the emerging impacts thatBrexit and Covid-19 are having on the poorest in UK society,she investigates the question of ‘where next for poverty andinequality in the UK’ and for policies in mitigating this.Dr Deborah Morris, Consultant Clinical Psychologistand Lead for the Centre for Developmental and ComplexTrauma, St Andrew’s Healthcare, and Elanor Webb, SeniorResearch Assistant at the Centre for Developmental andComplex Trauma, review the impact that models of traumainformed care (TIC) have had on improving care and qualityof life for people who have experienced trauma. They arguethat while TIC models represent a positive advancement,they pay insufficient consideration to the gendered needs(across the gender spectrum) of those who have beenexposed to trauma. TIC models also create artificial divisionsbetween psychological and physical health needs. Theyput forward an inclusive gender-mainstreamed approachto address these shortcomings and to more holisticallymeet the needs of the diverse groups exposed to trauma.Professor James Nazroo, Professor of Sociology at theUniversity of Manchester, critiques how policy, public andacademic understandings of race and ethnic inequalities areoften based on everyday and common-sense understandingsof what ethnicity represents, leading people to explainsuch inequalities in terms of supposed inherent ethnicdifferences. He argues that to inform more effective policyand practice responses to ethnic inequalities, a more robustapproach to theorising racism is needed, an approachhe proposes in his essay encompassing interconnectedstructural, interpersonal and institutional dimensions.Dr Sarah Anderson, Lecturer of Criminology at EdinburghNapier University, reviews existing literature and focuseson police contact and imprisonment to explore the rolesthat the youth and adult criminal justice systems in theUK play in perpetrating harm against people who oftenalso have past histories of trauma. In doing so, she raisescritical questions about what recognising the traumatisingeffects police contact and imprisonment could meanfor criminal justice policy and practice in the UK.Dr Michael Smith, Associate Medical Director ofMental Health and Addiction Services for NHS Glasgow,and Katy Hetherington, Childhood Adversity Leadfor Public Health Scotland, explore the limitations ofthe Adverse Childhood Experiences (ACEs) model inexplaining health inequalities in Scotland. They arguethat considering ACEs within a capabilities framework,based on social justice, human connectedness andrights and freedoms, can help to inform a more effectivepublic health response to the interconnections betweenpoverty, adversity, trauma and multiple disadvantage.Miranda Keast, independent researcher, explores, throughher previous work with Fulfilling Lives Lambeth, Southwarkand Lewisham (London), how a human rights approach,when combined with a capabilities lens, can be used bypractitioners and policy-makers to inform more effectiveresponses to people facing multiple disadvantage. Herrecommendations, developed through discussion withpractitioners from Fulfilling Lives, include the use of humanrights impact assessments by practitioners, servicesproviding greater flexibility, and for service providers toco-produce services alongside those who face multipledisadvantage as a way to help promote people’s capabilities.Finally, Professor Antonia Bifulco, Professor of LifespanPsychology and Director for the Centre for Abuse andTrauma Studies at Middlesex University, critically reviews thedifferent perspectives psychologists use for understandingchildhood trauma and its impacts on later life. She arguesthat it is only by taking a multi-perspective view that wecan better understand the impacts childhood trauma hasacross people’s lives and provide more effective care tothose who face, and have faced, such trauma. Based onher own research, she also illustrates how partnershipsbetween academics and practitioners can help inform bettercare provision to adolescents looked after by the state.

8The knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageEssay oneAuthorsSummaryA continuum of harm:How systemic interactionscan multiply and entrenchcomplex disadvantageDr. Diana F Johns(corresponding author)IntroductionThe University of Melbourne,School of Social and Political SciencesE: [email protected] de Loma-Osorio RiconDr Eric DommersBanksia Gardens Community Services9Together, as academics and practitioners, we explore the interconnectednessof poverty, trauma and multiple disadvantage in one of Australia’smost disadvantaged postcodes, which we call ‘Redlands’. In showinghow everyday encounters with adults in authority can cause harm,we take up the challenge to recognise the “impact of interactions withformal and informal social structures, institutions and processes uponthe lives of children and young people” (Armstrong, 2004, p.110).Literature reviewWe briefly review relevant literature on trauma, multiple disadvantage andsocial exclusion, outlining the Australian and local context to set the scenefor our discussion.Conceptual frameworkWe explain how we use the concepts of therapeutic justice, social ecologicaltheory, and the notion of a continuum of harm, as a framework for our analysis.Case studies, analysis and discussionWe draw on our work and practice experience in Redlands, using casestudies to show how everyday encounters with authority unfold in thelives of children and families living with poverty and trauma, and howthey can elicit reactions that exclude and punish. We explain how theseinteractions can normalise experiences of exclusion within families, andhow trauma and disadvantage can become embedded across generations.We also show how interactions with children and families can becomepositive, and how therapeutic intervention can interrupt these patterns.ConclusionWe conclude our discussion by highlighting the universal issues thatRedlands illustrates, and the policy and practice implications of thinkingand working through a therapeutic-ecological lens.FundingVictoria Government’s Department of Education and Training funded thework we describe as ‘Project Redlands’ in this paper. A range of philanthropicfunding has also been critical to developing the project since it began in 2017.

10The knot: An essay collection on the interconnectedness of poverty, trauma, and multiple disadvantageEveryday encounter #1: ‘Sally’Sally1, a 35-year-old mother of five, attends her firstappointment at the local health centre to developa mental health care plan. Sally is accompaniedby her community support worker, Helen. Thedoctor greets them both, invites them to sit downand asks Sally what has brought her to see him.Doctor: Good afternoon, I’m Dr Smith.How can I help you today?Sally: [announces loudly] I’m fucked in the head!Doctor: Excuse me, Ms we don’t tolerateany abusive behaviour in this clinic. I’m sorry,we’ll have to end this appointment.Helen: Are you kidding doctor? She wasn’t abusinganyone – she was just describing her state of mind!Doctor: I’m sorry. We have a zero-tolerance policy.If you don’t leave now, I’ll have to call security.Sally: It’s OK Helen, my bad! Let’s go.IntroductionThis paper explores the interconnectedness of poverty,trauma and multiple disadvantage in one of Australia’smost disadvantaged postcodes, an urban neighbourhoodcharacterised by entrenched social and economicdeprivation, drug-related crime and family violence. For thepurposes of our discussion, we will call this place ‘Redlands’2.This setting highlights universal issues: how childrengrowing up amid these (or similar) social conditionscan be harmed, not only by the direct consequencesof exposure to family and social adversity, but alsothrough their own and their communities’ entanglementand everyday encounters with services and systems –education, health, child protection and criminal justice– and with adults whose role affords them some authority.In this way, we take up the challenge to recognise the“impact of interactions with formal and informal socialstructures, institutions and processes upon the lives ofchildren and young people” (Armstrong, 2004, p.110).The snapshot of ‘Sally’s’ experience above illustratesseveral things: the doctor’s use of his title to assert hisauthority and to depersonalise the interaction, the useof the plural “we don’t tolerate” and “we have a zerotolerance policy”, distancing himself from his actions,and the closing down of any alternative course of1.action available at that moment with “if you don’t leavenow ”, which serves to alienate doctor from patientand divest the exchange of human empathy.Sally’s apparent docility suggests she is used to being ‘atfault’ and being put down (literally and figuratively). Her lowexpectations of people, particularly those in authority (whomay have let her down before), are thereby reinforced. Thisexperience might shape Sally’s willingness to engage withmedical professionals in the future, and her belief that theymight be trusted to help her. Perhaps more important, however,is the potential impact on Sally’s family. Would she be likelyto take her son ‘Ted’ to see a doctor following this encounter?What sort of assumptions might she pass on to her children?To explore some of these complexities we apply a twinconceptual lens – combining therapeutic justice and socialecological theory. Using this lens, we firstly explain howeveryday encounters with authority unfold in the lives ofchildren and families living with poverty and trauma, andhow they can elicit reactions that exclude and punish.Secondly, we show how, by amplifying and reproducingthe effects of trauma, such interactions can normaliseexperiences of exclusion within families. This can embedtrauma and structural disadvantage across generations andcommunities. Lastly, we draw on our experience working inRedlands to show, through this theoretical lens, how adultinteractions with children and families can become the site ofpositive interaction and therapeutic intervention, which caninterrupt these patterns. Before explaining these conceptsand their implications further, we present a snapshot ofa Redlands child’s interaction with adults in authority.Everyday encounter #2: ‘Brayden’12-year-old Brayden lives with his little brotherand sister, his mum and his stepdad, Matt, whomoved in a few months after Brayden’s dad wentto jail. Brayden is riding through the shoppingcentre on his scooter when two security guardstell him to stop. When he keeps riding, they grabhim by his clothes to confiscate the scooter.Guard 1: Hey, I’ve told you kids – noriding inside! I’ll take that scooter.Brayden: Piss off, you fuck’n dogs! That’s mine!Guard 2: If you want it back, you can comeand get it later from the security office. Butmake sure you bring one of your parents.Brayden: (Scared, mumbles to himself)Matt’s not gonna like this.All names in this paper are aliases to protect the anonymity of real people living in the place we call ‘Redlands’. The quotes, though not necessarily verbatim, reflect realconversations and situations witnessed and/or narrated by/to one or more of the authors, and recorded in their personal reflections. We’ve included these scenarios toillustrate common experiences in people’s everyday lives in t

with the criminal justice system because of traumatic life events, persistent poverty, and multiple unmet needs such as mental ill-health, homelessness and substance misuse. We work to create a smarter criminal justice system that makes the revolving door avoidable and escapable, resulting in safer communities. We do this by working alongside

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